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The Homecare Deficit 2018

A report on the funding of older people’s homecare across the United Kingdom

Over 4.1 million hours of state-funded homecare are purchased each week in the UK. This enables over 850,000 people to be supported at home and to live independently within their local community each year.

Homecare services make a major contribution to the wellbeing and safety of older and disabled people. Increasing attention is being paid to whether homecare services are sufficiently funded to be economically viable; whether local care markets are stable; and whether the homecare workforce are properly rewarded for the valuable work they undertake.

These concerns have been raised with increasing urgency for several years. In 2018, England’s Social Care regulator, the Care Quality Commission (CQC), stated its belief that the social care sector as a whole (including homecare services) had reached a ’tipping point’ – a point where deterioration in quality would outpace improvement and there would be a substantial increase in people whose needs were not being met. CQC had been warning that this would be the case in its annual reports for the two previous years.

The Commission comments that: “Problems with staff recruitment and retention are having an effect on local services’ capacity to provide stable eadership and meet the needs of people”.

The Commission also noted that the quality and access to social care services are inconsistent, the number of older people living with unmet needs has risen by almost 20%, and that Local Authorities tightening their eligibility criteria had resulted in 400,000 fewer older people receiving social care between 2008 and 2014.

There is evidence of homecare providers ceasing trading and handing back homecare contracts to their statutory sector purchasers on the basis of inadequate fee levels, with estimates of almost one third of councils in England (48) seeing homecare providers closing or ceasing to trade during a six-month period.

Most recently, 89% of leaders from local government in England said that they had either “no confidence”, or only “partial confidence”, that their social care budget would be sufficient to meet their statutory duties relating to the stability of local care markets by the end of 2019-20, when responding to a national survey.

Similar issues are thought to be affecting councils and the health and social care trusts in the three devolved administrations.

This report provides a snapshot of the rates councils in Great Britain and Northern Ireland’s Health and Social Care Trusts paid for older people’s homecare during a sample week in April 2018. We used data obtained from Freedom of Information requests to 211 public bodies, 208 of which confirmed that they purchased services from the independent and voluntary sector.